Inappropriate sinus tachycardia
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Inappropriate sinus tachycardia Microchapters |
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Differentiating Inappropriate Sinus Tachycardia from other Medical Conditions |
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Diagnosis |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: IST; chronic nonparoxysmal sinus tachycardia
Overview
Historical Perspective
Pathophysiology
Epidemiology and Demographics
Differentiating Inappropriate Sinus Tachycardia from other Medical Conditions
Differentiating Inappropriate Sinus Tachycardia from other Supraventricular Arrhythmias
Diagnosis
Treatment
Treatments in the form of pharmacological therapy or catheter ablation are available, although it is currently difficult to treat successfully.
Beta-blockers
In so far as the pathophysiology of IST involves abnormal sensitivity to adrenaline, betaa-blockers can be helpful.
Calcium Channel Blockers
Although calcium channel blockers slow conduction through the AV node, they have been marginally effective in the treatment of IST.
Ivabradine
A new selective sinus node inhibitor Ivabradine is also being used to treat IST.
Treatments Related to Dysautonomia and POTS
In so far as the underlying pathophysiology may involve a dysautonomia and features of Postural orthostatic tachycardia syndrome (POTS), some therapies more commonly used to treat these disorders have been tried:
Fludrocortisone (Florinef)
POTS and dysautonomia have been associated with decreases in blood volume, and this drug promotes sodium retention.
Midodrine
Midodrine increases vasoconstriction, and prevents falls in blood pressure.
Serotonin-reuptake inhibitors (SSRIs)
SSRIs have proven effective in treating some patients with dysautonomia.
Catheter Ablation
Invasive treatments include forms of Catheter ablation has gained favor among electrophysiologists in the treatment of IST.
Sinus Node Modification
This procedure involves selective ablation of the sinus node. The rhythm reoccurs in 80% of cases.
Complete Sinus Node Ablation
This procedure requires implantation of a Permanent Artificial pacemaker)
AV Node Ablation
In cases resistant to sinus node ablation, AV node ablation with creation of an iatrogenic complete heart block, may be neccessary. This procedure requires implantation of a permanent artificial pacemaker.
See also
- Supraventricular tachycardia
- Sinus tachycardia
- Postural orthostatic tachycardia syndrome
- Dysautonomia
References